Provider Demographics
NPI:1578873360
Name:KIWANIS FOUNDATION OF THE DISTRICT OF COLUMBIA
Entity Type:Organization
Organization Name:KIWANIS FOUNDATION OF THE DISTRICT OF COLUMBIA
Other - Org Name:KIWANIS ORTHOPEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:202-543-6840
Mailing Address - Street 1:900 2ND ST NE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3557
Mailing Address - Country:US
Mailing Address - Phone:202-543-6840
Mailing Address - Fax:202-543-6847
Practice Address - Street 1:900 2ND ST NE
Practice Address - Street 2:SUITE 306
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3557
Practice Address - Country:US
Practice Address - Phone:202-543-6840
Practice Address - Fax:202-543-6847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIWANIS FOUNDATION OF THE DISTRICT OF COLUMBIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870072261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation